Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study

• Published in: BMJ open Vol. 10; no. 12; p. e041138
• Main Authors: Ferreira, Elton C, Costa, Maria Laura, Pacagnella, Rodolfo C, Silveira, Carla, Andreucci, Carla B, Zanardi, Dulce Maria Toledo, Santos, Juliana P, Angelini, Carina R, Souza, Renato T, Parpinelli, Mary A, Sousa, Maria Helena, Cecatti, Jose Guilherme
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 10-12-2020; BMJ Publishing Group
• Series: Original research
• Subjects: Brazil - epidemiology; Child; Cohort analysis; Cohort Studies; Disability; Female; Humans; Morbidity; Obstetrics and Gynaecology; Post traumatic stress disorder; Pregnancy; Pregnancy Complications - epidemiology; Public health; Quality of Life; Questionnaires; Reproductive health; Retrospective Studies; Womens health; Brazil; perinatology; maternal medicine; developmental neurology & neurodisability; public health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-041138

ObjectivesTo perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children.DesignA retrospective cohort study.SettingA tertiary maternity hospital from the southeast region of Brazil.ParticipantsThe exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth.Primary and secondary outcome variablesValidated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview.ResultsAll instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold).ConclusionSMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.